TY - JOUR
T1 - Polypharmacy and frailty among aging World Trade Center responders
AU - Venkatram, Chinmayi
AU - Ko, Fred
AU - Bello, Ghalib
AU - Sabra, Ahmad
AU - Thompson, Hannah M.
AU - Thanik, Erin
AU - Colicino, Elena
AU - Lucchini, Roberto G.
AU - Crane, Michael
AU - Teitelbaum, Susan L.
AU - Ornstein, Katherine A.
AU - Hung, William W.
N1 - Publisher Copyright:
© 2025 Venkatram et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2025/12
Y1 - 2025/12
N2 - Background During and after the 9/11 rescue and recovery efforts, World Trade Center (WTC) responders were exposed to environmental hazards that may accelerate aging and increase frailty. This study examines the relationship between polypharmacy and frailty among WTC responders to inform strategies that mitigate medication-related risks in high-risk, aging populations. Methods We included WTC responders aged 50 and older who attended at least one clinical monitoring visit at WTC Health Program between 2017–2019. Frailty was assessed using the WTC-specific Clinical Frailty Index, and associations with polypharmacy (concurrent use of 5 or more medications) and fall-risk increasing drugs (FRIDs) use were evaluated through multivariable logistic regression models adjusting for demographic, employment, health, and WTC exposure data. Results Among 6,966 WTC responders, 55% met the criteria for polypharmacy and 7.6% used FRIDs. Frailty was independently associated with both polypharmacy (OR 1.15, p<0.001) and FRID use (OR 1.11, p<0.001). Older age (OR 1.08, p<0.001), obesity (OR 1.92, p<0.001 for BMI≥30), protective service occupations (OR 1.30, p=0.002), and chronic conditions such as gastroesophageal reflux disease (OR 1.71, p<0.001), obstructive airway disease (OR 2.24, p<0.001), and upper respiratory disease (OR 1.85, p<0.001) were associated with higher odds of polypharmacy. In contrast, male sex (OR 0.81, p=0.018) and construction occupations (OR 0.73, p=0.001) were associated with lower odds of polypharmacy. Female sex (OR 1.64, p<0.001), smoking (current: OR 1.55, p=0.013; former: OR 1.30, p=0.014), and mental health conditions such as anxiety (OR 1.66, p=0.004), depression (OR 2.85, p<0.001), and post-traumatic stress disorder (OR 1.72, p<0.001) were associated with higher odds of FRID use. Conclusions We found a high prevalence of polypharmacy and FRID use among aging WTC responders, with frailty significantly associated with both. Our findings underscore the need to optimize medication management for aging WTC responders, which may impact their healthy aging.
AB - Background During and after the 9/11 rescue and recovery efforts, World Trade Center (WTC) responders were exposed to environmental hazards that may accelerate aging and increase frailty. This study examines the relationship between polypharmacy and frailty among WTC responders to inform strategies that mitigate medication-related risks in high-risk, aging populations. Methods We included WTC responders aged 50 and older who attended at least one clinical monitoring visit at WTC Health Program between 2017–2019. Frailty was assessed using the WTC-specific Clinical Frailty Index, and associations with polypharmacy (concurrent use of 5 or more medications) and fall-risk increasing drugs (FRIDs) use were evaluated through multivariable logistic regression models adjusting for demographic, employment, health, and WTC exposure data. Results Among 6,966 WTC responders, 55% met the criteria for polypharmacy and 7.6% used FRIDs. Frailty was independently associated with both polypharmacy (OR 1.15, p<0.001) and FRID use (OR 1.11, p<0.001). Older age (OR 1.08, p<0.001), obesity (OR 1.92, p<0.001 for BMI≥30), protective service occupations (OR 1.30, p=0.002), and chronic conditions such as gastroesophageal reflux disease (OR 1.71, p<0.001), obstructive airway disease (OR 2.24, p<0.001), and upper respiratory disease (OR 1.85, p<0.001) were associated with higher odds of polypharmacy. In contrast, male sex (OR 0.81, p=0.018) and construction occupations (OR 0.73, p=0.001) were associated with lower odds of polypharmacy. Female sex (OR 1.64, p<0.001), smoking (current: OR 1.55, p=0.013; former: OR 1.30, p=0.014), and mental health conditions such as anxiety (OR 1.66, p=0.004), depression (OR 2.85, p<0.001), and post-traumatic stress disorder (OR 1.72, p<0.001) were associated with higher odds of FRID use. Conclusions We found a high prevalence of polypharmacy and FRID use among aging WTC responders, with frailty significantly associated with both. Our findings underscore the need to optimize medication management for aging WTC responders, which may impact their healthy aging.
UR - https://www.scopus.com/pages/publications/105023912351
U2 - 10.1371/journal.pone.0337391
DO - 10.1371/journal.pone.0337391
M3 - Article
C2 - 41343525
AN - SCOPUS:105023912351
SN - 1932-6203
VL - 20
JO - PLoS ONE
JF - PLoS ONE
IS - 12 December
M1 - e0337391
ER -